What factors affect patient adherence to treatment?
· For example, medication adherence is crucial for persons infected with human immunodeficiency virus (HIV), because treatment lowers the amount of virus circulating in the blood, which improves the patient’s health and reduces the …
What drives adherence rates in primary care patients?
Antiretroviral therapy (ART) is recommended for all people living with HIV, regardless of CD4 cell count, to consistently suppress viral load, maintain high CD4 cell counts, prevent AIDS, prolong survival, and reduce risk of transmitting HIV to others. 1, 2, 3 Research demonstrates that the success of ART, however, depends on the extent to which a patient takes his or her treatment …
Why is medication adherence important for patients with high blood pressure?
· Adherence matters. High adherence to antihypertensive medication is associated with higher odds of blood pressure control, but non-adherence to cardioprotective medications increases a patient’s risk of death from 50% to 80%. 1. As a health care professional, you can empower patients to take their medications as prescribed.
Which adherence assessments are most effective?
Which of the following diseases is known to have high treatment adherence among patients? Chiropractic medicine _____ involves performing adjustments on the spine and joints to correct misalignments that are believed to both prevent and cure illness.
Is the most commonly used complementary and alternative medicine therapy among US adults?
The most frequently seen providers for CAM treatments were physicians (71.0% of patients), spiritual healers (29.0%), and chiropractors (20.3%). CAM treatments most frequently received from a physician were massage therapy (51.0%), hijama (38.8%), spiritual healing (24.5%), and acupuncture or herbs (16.3%).
What is an alternative medical practice that draws on the body's ability to heal itself?
Homeopathy (or homoeopathy) is a 200-year-old form of alternative medicine that claims to stimulate a healing response and strengthen the body's ability to heal itself.
Which of the following is the first stage of delay in seeking treatment for symptoms?
On the basis of the patients' retrospective report, the total time from first noticing a symptom to the seeking of treatment was divided into three sequential stages: 1) appraisal delay--the time the patient takes to appraise a symptom as a sign of illness; 2) illness delay--the time taken from deciding one is ill ...
Which of the following results in the misinterpretation of health information?
Which of the following results in the misrepresentation of health information? A patient's conceptions of his or her illness differs from the health care provider's conception of it. honest mistakes.
Which of these complementary and alternative treatments originated in India?
Examples of complementary and alternative medicine healing systems include Ayurveda, which originated in India more than 5,000 years ago, emphasizes a unique cure per individual circumstances.
What is alternative medicine called?
Alternative medicine is a term that describes medical treatments that are used instead of traditional (mainstream) therapies. Some people also refer to it as “integrative,” or “complementary” medicine. More than half of adults in the United States say they use some form of alternative medicine.
What is a delay in treatment?
A delay in treatment is when a patient does not get a treatment – whether it be a medication, lab test, physical therapy treatment, or any kind of treatment – that had been ordered for them in the time frame in which it was supposed to be delivered.
Which of the following is a chronic health disorder?
Chronic diseases - such as heart disease, cancer, diabetes, stroke, and arthritis - are the leading causes of disability and death in New York State and throughout the United States.
What is a delayed patient?
According to the Joint Commission, a delay in diagnosis is a non-optimal interval of time between the onset of symptoms and the identification of the treatment needed. A delay in treatment occurs if the patient does not actually receive the laboratory test, physical therapy, or medication that has been prescribed.
What is a treatment error?
Treatment errors were defined in the study as any error in the performance of an operation, procedure, or test; in the administration of treatment; in the dosage or method of drug use; and, generally, inappropriate care (Leape 2002, Kohn et al. 1999).
How much information do patients retain?
Patients remember as little as a fifth of information discussed and immediately forget 40%-80% of the content of their medical encounters.
What are diagnostic errors in healthcare?
Diagnostic errors are a failure to provide an accurate and timely explanation of the patient's health problems or communicate that explanation to the patient (4). They are considered as missed opportunities to make a correct or timely diagnosis based on available evidence.
What are the factors that affect medication adherence?
Medication adherence is a complex behavior influenced by factors along the continuum of care, relating to the patient, providers, and health systems ( 8 ). Patient-related factors include unintentional factors, which often worsen with increasingly complex medication regimens (e.g., forgetting to take medication or obtain refills, or inadequate understanding of dose or schedules); and intentional factors (e.g., active decision to stop or modify a treatment regimen based on ability to pay, beliefs and attitudes about their disease, medication side effects, and expectations for improvement) ( 9) ( Figure ). Additional patient-related barriers include lack of engagement in treatment decisions, impaired cognition (e.g., related to aging or disease), substance abuse, depression, and other mental health conditions. Provider-related factors include barriers to communicating with patients and their caregivers, complex dosing regimens, and limited coordination of care among multiple providers. Health care system and service delivery factors include limited access to an appropriate provider for prescriptions or refills, restricted drug coverage, high costs and copayments, unclear medication labeling and instructions, limited availability of culturally appropriate patient education materials, and inadequate provider time to review benefits, risks, and alternatives to prescribed medications.
How does medication adherence affect health?
In the United States, 3.8 billion prescriptions are written annually ( 3 ). Approximately one in five new prescriptions are never filled, and among those filled, approximately 50% are taken incorrectly, particularly with regard to timing, dosage, frequency, and duration ( 4 ). Whereas rates of nonadherence across the United States have remained relatively stable, direct health care costs associated with nonadherence have grown to approximately $100–$300 billion of U.S. health care dollars spent annually ( 5, 6 ). Improving medication adherence is a public health priority and could reduce the economic and health burdens of many diseases and chronic conditions ( 7 ).
What is the priority for developing sustainable strategies to improve medication adherence?
One priority for developing sustainable strategies to improve medication adherence includes standardizing research methodology for both clinic and research settings. Currently, studies use a variety of measurement methods.
How can medication adherence be improved?
One priority for developing sustainable strategies to improve medication adherence includes standardizing research methodology for both clinic and research settings. Currently, studies use a variety of measurement methods. Varying study methodologies prevents comparability across interventions, hinders wide application into clinical practice, and limits efforts that focus on patients with the greatest burden and need. Standardization might also help to understand both the dose-response and effectiveness of interventions over a longer time, increasing sustainability and reducing a waning effect at follow-up time points ( 21 ).
How does electronic prescribing improve medication adherence?
Advances in health information technology can also improve medication adherence. In a 2011 study, providers using electronic prescribing (e-prescribing) increased first-fill medication adherence by 10% compared with those using paper prescriptions ( 18 ). Some e-prescribing software can monitor prescriptions dispensed or unfilled in near real-time, as well as send patients prompts when a new or refill prescription is available. These data allow providers to review current medication use with patients during office visits, identify gaps or barriers to adherence, and discuss workable solutions.
How does system based care address health disparities?
System-based strategies that address health disparities can improve clinical goals or reduce disease burden. For example, medication adherence is crucial for persons infected with human immunodeficiency virus (HIV), because treatment lowers the amount of virus circulating in the blood, which improves the patient’s health and reduces the risk of transmitting HIV to others by >90% ( 15 ). Interventions, such as CDC’s Data to Care ( 16) strategy, that identify and re-engage nonadherent patients in care by linking them through the health department, their care providers, or both, improve the health of the individual and achieve the public health benefit of reducing HIV transmission ( 17 ).
How to improve adherence to medication?
A proven cost-effective strategy to reducing unintentional nonadherence is the use of pillboxes and blister packs to organize medication regimens in clear and simple ways ( 10 ). Combining the ease of packaging with effective behavioral prompts, such as electronic pill monitors that can remind patients to take their medication and provide messages to health care providers when a scheduled drug-dose is missed, supports increased medication adherence ( 11 ).
How can HIV care providers communicate the benefits of adherence?
For example, HIV care providers can communicate the benefits of adherence by explaining that with ART medications, patients can now expect to live longer lives if they adhere to their ART regimen exactly as prescribed. Patients entering care should also understand the potential negative consequences of nonadherence such as increased mortality ...
How to help HIV patients with nonadherence?
Ensure patients understand the treatment plan, including drug regimen, dosing schedule, and dietary restrictions. Prepare patients for situations or changes in routine that could trigger nonadherence or short-term interruption, such as side effects, substance use, or running out of HIV medicines. Remind patients to contact their HIV care provider or pharmacist immediately if they are experiencing side effects or need to refill medication prescriptions. Encourage patients to discuss their challenges with substance use and offer information or referrals for treatment options and support services.
What are the barriers to adherence to ART?
Barriers to ART adherence may arise from a patient’s personal or cultural beliefs, cognitive abilities, or health status, including comorbidities. 3, 4, 5 A patient’s capacity for treatment competence or regimen-specific barriers also may impact adherence, as well as psychosocial or structural issues such as poor mental health, drug use, or even lack of housing or health insurance. 3, 4, 5
What is the first step to successful ART adherence?
Recent findings show that assessing a patient’s ART readiness is the first step to successful ART adherence. 6 Patients starting ART should be willing and able to commit to treatment and understand the benefits and risks of therapy and the importance of adherence.
Why is objectivity important in HIV care?
Objectivity and a nonjudgmental attitude are important. Health care providers can make it clear that even if they do not share patients’ views, they respect them. By understanding and respecting patients’ views, HIV care providers have the opportunity to improve the patient-health care provider relationship and make the patient more likely to be open and adherent.
How can HIV care providers help patients?
Establishing ongoing brief conversations with patients in a supportive and nonjudgmental way encourages trust and facilitates opportunities to identify teachable moments in which HIV care providers can better help patients achieve sustained viral suppression. For example, HIV care providers can communicate the benefits of adherence by explaining that with ART medications, patients can now expect to live longer lives if they adhere to their ART regimen exactly as prescribed. Patients entering care should also understand the potential negative consequences of nonadherence such as increased mortality and morbidity, drug resistance, and risk of transmitting HIV to others. 3, 6
Is adherence to ART long term?
Adherence to ART over the long term can be challenging, even for the most motivated patients. As recent research demonstrates, brief discussions about ART adherence at every follow-up visit can help improve patient success. 6 Following are a few questions probing ongoing adherence:
What is the importance of medication adherence?
Medication adherence is critical to successful hypertension control for many patients . However, only 51% of Americans treated for hypertension follow their health care professional’s advice when it comes to their long-term medication therapy. 1. Adherence matters.
How to empower patients to take their medications?
As a health care professional , you can empower patients to take their medications as prescribed. Effective two-way communication is critical; in fact, it doubles the odds of your patients taking their medications properly. Try to understand your patients’ barriers and address them honestly to build trust.
What questions should a patient ask about taking medications?
Ask patients specific questions about attitudes, beliefs, and cultural norms related to taking medications.
When to ask for patients' input?
Ask for patients’ input when discussing recommendations and making decisions.
What is the purpose of talking to patients?
Talk to patients to understand and address their concerns or fears.
Does adherence to antihypertensive medications increase risk of death?
Adherence matters. High adherence to antihypertensive medication is associated with higher odds of blood pressure control, but non-adherence to cardioprotective medications increases a patient’s risk of death from 50% to 80%. 1. As a health care professional, you can empower patients to take their medications as prescribed.
How do patients' intentions to adhere to their recommended treatments relate to their choices regarding medical treatments?
In a study we are currently conducting in conjunction with the Bayer Institute for Health Care Communication, our preliminary findings suggest that (in a US sample) patients' intentions to adhere to their recommended treatments are significantly correlated with having choices regarding medical treatments; having the opportunity to discuss their care with their physicians; having their preferences taken into account; and having a doctor who communicates well (all significant at p < 0.001). In addition, preliminary data confirm and extend previous research showing that the amount of trust patients have in their physicians is a strong predictor of whether they plan to carry out treatment recommendations.
How does adherence to a treatment regimen affect quality of care?
Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors. These include realistic assessment of patients' knowledge and understanding of the regimen, clear and effective communication between health professionals and their patients, and the nurturance of trust in the therapeutic relationship. Patients must be given the opportunity to tell the story of their unique illness experiences. Knowing the patient as a person allows the health professional to understand elements that are crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social supports, and emotional health challenges, particularly depression. Physician–patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence. Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and improves patients' healthcare outcomes.
How does patient involvement affect patient satisfaction?
Studies have found that both patient satisfaction and patient adherence are enhanced by patients' involvement and participation in their care (Martin et al 2001, 2003). The behavior of physicians and patients tends to be reciprocal when they strive toward partnership. Patients who want to be more involved tend to ask more questions and display more confidence, and physicians who are willing to sustain collaborative relationships with their patients tend to act in ways that prompt their patients to be involved and active (Street et al 2003). Research has also shown that patients who participate in discussions of behavioral strategies with their doctor are more likely to adhere to antidepressant medication (Lin et al 1995). Physician–patient partnership and social support from health professionals, as well as from members of the patient's social network, are essential to patients' adherence to recommended treatments (DiMatteo et al 1994; DiMatteo 2004a, 2004c).
How does trust affect patients?
Patients' trust in their physicians is essential to their emotional disclosure and is therefore a crucial component of the patient–physician relationship. Patients must believe that their physician is someone who can understand their unique experience of being a patient, and someone who can provide them with reliable and honest advice (Branch 2000). Trusting relationships between physicians and patients can greatly affect patient outcomes. For example, it has been shown that physicians who promote trust in the therapeutic relationship, who have effective communication and “bedside manner”, and who express compassion for their patients succeed in fostering cooperation and patient adherence with a variety of preventive and treatment recommendations (O'Malley et al 2002). Adherence rates have been found to be nearly 3 times higher in primary care relationships characterized by very high levels of trust coupled with physicians' knowledge of the patient as a whole person. In fact, patients' trust in their physician has been found to far exceed many other variables when it comes to promoting patients' satisfaction with their care (Safran et al 1998).
How does interpersonal communication affect patient outcomes?
Additionally, when physicians and patients agree on how involved patients should be in their care, adherence is improved (Jahng et al 2005). Cohesive partnerships and effective interpersonal communication make it possible for patients and physicians to work together to help patients follow mutually agreed-upon recommendations (Jahng et al 2005). Successful communication between physicians and patients promotes greater patient satisfaction with medical care, which in turn fosters higher levels of adherence.
How does health literacy affect patients?
Patients' health beliefs are affected by their health literacy, and these beliefs are also contributors to (non)adherence. In a study of asthmatic patients who were given extensive, high-quality information on the use of daily inhaled corticosteroids, only 38% adhered to their medication regimen, whereas the other 62% continued to mistakenly believe that their medication should only be taken when they were symptomatic (Anarella et al 2004). In practice, patients' low health literacy has been linked to ineffective physician–patient communication and, in particular, physicians' failure to assess recall and comprehension of new concepts with their patients (Schillinger et al 2003). Low health literacy has been associated with patient depression (Kalichman 1999) and consequently with the manner in which patients communicate with their doctors. Patient health literacy issues may also be tied to ethnic disparities in screening, such as mammography, probably because of reduced access to and understanding of written cancer prevention materials (Peek and Han 2004).
Why is health literacy important?
Thus, patients' health literacy is central to their ability to adhere. According to Healthy People 2010, health literacy involves the “degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (US DHHS 2000, p 20). Studies show that the risk of nonadherence is very high when patients cannot read and understand basic written medical instructions. Misunderstanding of this type is not as uncommon as one might imagine. One large study of over 2500 patients found that nearly one third had marginal or inadequate health literacy. Of these, 42% misunderstood directions for taking medications on an empty stomach, 25% misunderstood the scheduling of their next appointment, and nearly 60% were unable to read and understand a typical informed consent document (Williams et al 1995). Language barriers contributed somewhat to these limitations, but even when patients could understand the language of their medical instructions, many could not comprehend the medical information. Further, older patients in this study had significantly more problems understanding their medical regimens than did younger patients. Other studies confirm these trends and indicate that our current interventions aimed at increasing health literacy to improve patient adherence have, so far, been disturbingly ineffective (Williams et al 1998; Gazmararian et al 1999; Schillinger et al 2003).
What is stage 2 hypertension?
People who have a blood pressure at or above 140/90 mm Hg , also known as stage 2 hypertension, and are particularly in need of lowering their blood pressure. Figure 1.
What is the most common cause of death in the United States?
Hypertension, also known as high blood pressure, increases the risk for heart disease and stroke, two leading causes of death for people in the United States. 1
Can you use lifestyle modifications with blood pressure medication?
People with hypertension who are recommended to use either lifestyle modifications only or lifestyle modifications with prescription medication to manage their blood pressure.
What are the barriers to treatment adherence?
Cost and poor understanding of the directions for the treatment, referred to as ' health literacy ' have been known to be major barriers to treatment adherence. There is robust evidence that education and physical health are correlated. Poor educational attainment is a key factor in the cycle of health inequalities.
Why is it called "adherence" to a regimen?
As of 2003, US health care professionals more commonly used the term "adherence" to a regimen rather than "compliance", because it has been thought to reflect better the diverse reasons for patients not following treatment directions in part or in full.
How many elderly patients do not know the purpose of their regimen?
They found that 40% of elderly patients do not know the purpose of their regimen and only 20% knew the consequences of non-adherence. Comprehension, polypharmacy, living arrangement, multiple doctors, and use of compliance aids was correlated with adherence.
What is the difference between adherence and concordance?
As of 2005, the preferred terminology remained a matter of debate. As of 2007, concordance has been used to refer specifically to patient adherence to a treatment regimen which the physician sets up collaboratively with the patient, to differentiate it from adherence to a physician-only prescribed treatment regimen. Despite the ongoing debate, adherence has been the preferred term for the World Health Organization, The American Pharmacists Association, and the U.S. National Institutes of Health Adherence Research Network. The Medical Subject Headings of the United States National Library of Medicine defines various terms with the words adherence and compliance. Patient Compliance and Medication Adherence are distinguished under the MeSH tree of Treatment Adherence and Compliance .
What is concordance in healthcare?
The term concordance has been used in the United Kingdom to involve a patient in the treatment process to improve compliance, and refers to a 2003 NHS initiative. In this context, the patient is informed about their condition and treatment options, involved in the decision as to which course of action to take, and partially responsible for monitoring and reporting back to the team.
What is compliance in medicine?
Terminology. In medicine, compliance (synonymous with adherence, capacitance) describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to medical device use, self care, self-directed exercises, or therapy sessions.
What is the process by which a patient and clinician make decisions together about treatment?
Compliance can be confused with concordance , which is the process by which a patient and clinician make decisions together about treatment.
Abstract
Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings.
Background
The increase in life expectancy and the aging of the world population have been paralleled by an alarming growth in the global burden of chronic conditions [ 1 ]. Chronic diseases are generally considered physical or mental conditions that last more than a year and require ongoing care.
Methods
A cross-sectional study was conducted in two primary healthcare centers between August 2016 and March 2017 in Soria, an urban city of 39,000 inhabitants located in the autonomous community of Castile and Leon, Spain.
Results
Among the 344 eligible patients randomly invited to participate in the study, 41 (11.9%) refused to participate and 4 (1.2%) withdrew during the interview process. The characteristics of the excluded subjects were similar to those of the overall group.
Discussion
To our knowledge, this is the first attempt to determine factors associated with adherence under the WHO multidimensional framework in patients with chronic conditions in primary care settings in Spain.
Conclusions
Adherence to long-term treatments for chronic conditions remains a challenging issue in primary care. A low proportion of patients followed the recommendations from healthcare providers which underlines the need of reinforcing medication adherence in primary care. Our results should help to design new interventions aimed to enhance adherence.
Availability of data and materials
Data will be available upon reasonable request from the corresponding author.
